Nephrotoxicity in survivors of Wilms' tumours in the North of England

One aspect of concern for survivors of Wilms' tumour has been the late outcome in terms of renal function. Previous studies have documented low glomerular filtration rate and high blood pressure in some patients. Furthermore, disorders in tubular function (especially urinary concentration defects) have been suggested but not confirmed in small studies. The aim of this study was to determine the prevalence and nature of subclinical and overt glomerular, proximal and distal renal tubular toxicity in a population based cohort of survivors of Wilms' tumour. Forty patients (24 female) with a median age of 4.3 years (3 months–11.8 years) at diagnosis were studied. Median follow-up was 8.8 (range 0.06–27.5) years. Glomerular filtration rate was measured by 51Cr-EDTA plasma clearance, proximal tubular function by electrolyte fractional excretions, urine excretion of low molecular weight proteins (retinol-binding protein) and renal tubular enzymes (alanine aminopeptidase; N-acetylglucosaminidase) and distal tubular function by the osmolality of the first two urines of the day on 3 consecutive days. Renal size (ultrasound) and blood pressure were also measured. Mean (range) glomerular filtration rate was 100 (61–150) ml min−1 1.73 m−2. Nine were below the reference range for healthy individuals with two kidneys. Most serum electrolyte concentrations (sodium, potassium, chloride, calcium, magnesium and phosphate) fell within the normal range for age, as did the fractional excretions. The values that fell outside the normal range were only marginally abnormal. Subclinical measures of tubular toxicity (retinal-binding protein, alanine aminopeptidase, N-acetylglucosaminidase) were abnormal in only four patients. Thirty-seven patients achieved maximal urine osmolalities ⩾800 mOsm kg−1, but three failed to achieve this value even after DDAVP administration. Two patients had evidence of increased urinary albumin excretion. Compensatory renal hypertrophy was seen in all but two patients, but blood pressure was within normal limits in all patients. Current and past treatment for Wilms' tumour does not have any clinically important nephrotoxic effect in the majority of patients. This finding will enable paediatric oncologists to reassure patients and parents that treatment for Wilms' tumour rarely causes long-term renal impairment

Sociolinguistic approaches to writing systems research.

Writing systems have attracted relatively little attention from sociolinguists, in spite of obvious connections with subjects of great sociolinguistic interest, such as ethnicity and identity. In fact, the literature contains a substantial amount of research on writing systems from a sociolinguistic perspective, but there is no recognised ‘sociolinguistics of writing systems’ within which different case studies can be researched and compared from a social and cultural point of view. This article will discuss and review research in the sociolinguistics of both writing systems and orthographies, taking a perspective drawn from literacy studies which treats writing systems as social practice. The paper will focus on stages of writing system development where social and cultural considerations typically play a role: the initial choice of script, the period when the orthography and/or script is developed, and once it is an established system in regular use. There is also a discussion of how social and cultural factors are involved in, and often stand in the way of, writing system reform. This article will discuss and review research in the sociolinguistics of both writing systems and orthographies, taking a perspective drawn from literacy studies which treats writing systems as social practice. The paper will focus on stages of writing system development where social and cultural considerations typically play a role: the initial choice of script, the period when the orthography and/or script is developed, and once it is an established system in regular use. There is also a discussion of how social and cultural factors are involved in, and often stand in the way of, writing system reform